Importance: In 2010, national payers announced they would begin using patient satisfaction scores to adjust reimbursements for surgical care. Objective: To determine whether patient satisfaction is independent from surgical process measures and hospital safety. Design: We compared the performance of hospitals that participated in the Patient Satisfaction Survey, the Centers for Medicare&Medicaid Services Surgical Care Improvement Program, and the employee Safety Attitudes Questionnaire. Setting: Thirty-one US hospitals. Participants: Patients and hospital employees. Interventions: There were no interventions for this study. Main Outcomes and Measures: Hospital patient satisfaction scores were compared with hospital Surgical Care Improvement Program compliance and hospital employee safety attitudes (safety culture) scores during a 2-year period (2009-2010). Secondary outcomes were individual domains of the safety culture survey. Results: Patient satisfaction was not associated with performance on process measures (antibiotic prophylaxis, R=-0.216 [P=.24]; appropriate hair removal, R=-0.012 [P=.95]; Foley catheter removal, R=-0.089 [P=.63]; deep vein thrombosis prophylaxis, R=0.101 [P=.59]). In addition, patient satisfaction was not associated with a hospital's overall safety culture score (R=0.295 [P=.11]).We found no association between patient satisfaction and the individual culture domains of job satisfaction (R=0.327 [P=.07]), working conditions (R=0.191 [P=.30]), or perceptions of management (R=0.223 [P=.23]); however, patient satisfaction was associated with the individual culture domains of employee teamwork climate (R=0.439 [P=.01]), safety climate (R=0.395 [P=.03]), and stress recognition (R=-0.462 [P=.008]). Conclusions and Relevance: Patient satisfaction was independent of hospital compliance with surgical processes of quality care and with overall hospital employee safety culture, although a few individual domains of culture were associated. Patient satisfaction may provide information about a hospital's ability to provide good service as a part of the patient experience; however, further study is needed before it is applied widely to surgeons as a quality indicator.
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